Ductal shunting, high pulmonary blood flow, and pulmonary hemorrhage

doi:10.1067/mpd.2000.106569

The Journal of Pediatrics

Volume 137, Issue 1, July 2000, Pages 68-72

https://doi.org/10.1067/mpd.2000.106569 Get rights and content

Abstract

Objective: To describe the relationship among ductal shunting, estimated pulmonary blood flow, and pulmonary hemorrhage in very preterm infants. Study design: A total of 126 babies born before 30 weeks’ gestation (median gestation 27 weeks, range 23 to 29 weeks) underwent echocardiography at 5, 12, 24, and 48 hours of age; measurements included right and left ventricular output, superior vena cava flow, and color Doppler diameter of any ductal shunt. Pulmonary blood flow was derived from the sum of right ventricular output and estimated ductal shunt flow. Results: Twelve (9.5%) babies had a pulmonary hemorrhage at a mean age of 38 hours. Compared with the rest of the cohort, these 12 babies were less likely to have had antenatal steroids (59% vs 90%) and were less mature (26 weeks vs 27 weeks). At the echocardiogram closest to the pulmonary hemorrhage, 11 (92%) of the 12 babies had a significant patent ductus arteriosus >1.6 mm in diameter (median 2 mm, range 0.7 to 2.4 mm), and the median pulmonary blood flow was 326 mL/kg/min (range 210 to 598 mL/kg/min). These measurements were significantly higher than those found in the rest of the cohort in the same period (median duct diameter 0.5 mm [range 0 to 2.9 mm], median pulmonary blood flow 237 mL/kg/min [range 107 to 569 mL/kg/min]). At 5-hour echocardiography the babies with pulmonary hemorrhage had significantly larger diameter ducts but similar pulmonary blood flow. Conclusions: Pulmonary hemorrhage in preterm babies is associated with significant ductal shunting and high estimated pulmonary blood flow. (J Pediatr 2000;137:68-72)

Section snippets

Study Population

The entry criteria were preterm birth before 30 weeks’ gestation and informed parental consent. The 126 babies enrolled during a 20-month period represented 85% of eligible babies. Parental consent was refused in 5 babies, and 19 eligible babies were not studied, because neither investigator was available when they were born. The 126 babies had a mean gestation of 27 weeks (range 23 to 29 weeks) and a mean birth weight of 991 g (range 420 to 1630 g); 52% were male, 87% had received some

Results

Twelve (9.5%) of the 126 babies had a pulmonary hemorrhage at a mean age of 38 hours (range 14 to 55 hours). In 9 of these babies, the appearance of the aspirated fluid was of frank blood; in 3, it was of blood-stained fluid. The median increase in oxygenation index caused by the pulmonary hemorrhage was 8.9 (range 1 to 33), and the mean maximum PCO₂ during the acute respiratory deterioration was 60 mm Hg (range 35 to 86 mm Hg).

Demographic and clinical characteristics of these 12 babies were

Discussion

These data have confirmed an association between pulmonary hemorrhage and significant left to right ductal shunting with resultant high estimated pulmonary blood flow. This study has 2 limitations. First, because pulmonary hemorrhage is an unpredictable acute event, we were unable to perform echocardiograms at a consistent time in relation to the pulmonary hemorrhage. Despite this, these data still represent the closest hemodynamic data in relation to a pulmonary hemorrhage currently available

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Proactive managements for reducing unnecessary use of pulmonary surfactant and for decreasing the risk of sPDA at the beginning of life could be recommended as preventive strategies to reduce the risk of MPH in extremely preterm infants. ACS therapy is highly recommended for women with a high likelihood of giving birth preterm to reduce the risk of mortality caused by MPH.
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Original ArticlesDuctal shunting, high pulmonary blood flow, and pulmonary hemorrhage☆

Abstract

Section snippets

Study Population

Results

Discussion

Lancet

J Pediatr

J Pediatr

Ultrasound Med Biol

J Pediatr

J Pediatr

J Pediatr

Original Articles
Ductal shunting, high pulmonary blood flow, and pulmonary hemorrhage☆